There are valid points contained in both letters. The placebo effect remains alive and well, while the limitations of clinical trials are also well known – e.g., potentially beneficial combination therapies are ignored, etc. Importantly, however, the gorilla in this room and I generally get along.

I have multiple sclerosis, and I am a veteran. Also, by way of context, I was a finance guy, i.e., an analyst, a banker, a director, a president, etc. – you know, a lifelong capitalist. Let me describe a conundrum and introduce you to our hairy friend.

My annual average wholesale pharmacological cost runs about $89,829 (that does not include consultations, examinations, infusions, emergency visits, MRIs, X-rays, therapies, travel costs, etc.). My priciest drug is Tysabri at $75,715 annually (believe it or not, that price is at the low end of the available MS drug cost spectrum). So, what do I pay as a veteran?

The U.S. Department of Veterans Affairs (VA) manages the Federal Supply Schedule (FSS), who together support the purchase of millions of health care products and services for use by the VA and other federal agencies.

The most expensive drug I use, Tysabri, costs the VA $37,574, not $75,715, and of course a question arises. Why do they pay so much less? The capitalist in me knows why. The VA is allowed to negotiate as a combined buyer group, so the intersection of supply and demand, the drug price, is lower, and yet, you the consumer cannot legally do that.

Often, the counterargument goes like this: The VA’s price exists outside a “normal market.” The government allows veterans to pool and negotiate price, and without benefit of their affiliation as U.S. veterans, they wouldn’t be able to organize or negotiate in that fashion.

That is simply nonsense, and it runs counter to any existing and functioning free-market capitalist system. Organizing, frankly, is what we were trained to do.

Here’s a final twist: What do I pay annually out of pocket for all my medical care? It typically runs me about $824, but, of course, to get that kind of deal all you’ve got to do is fight and win a cold war, or just think that you did.